Previous research was conducted under rather controlled conditions not conforming to the procedures usually performed in a manual therapy treatment. Physiotherapists (PTs) in the present study focussed his or her mobilisation or manipulation on the actual area of impairment of each participant. Thus, this study is the first one that investigates the effect of these different techniques on the cervical and thoracic region in a pragmatic way. Therefore, this pragmatic study design allowed to examine the interventions in a very clinical way.

The PTs screened for contraindications of thrust manipulations according to IFOMPT standards and were able to exclude ineligible participants from the study.

Each treatment was based on an individual assessment.

Intensity, time span, and even the technique of the thrust manipulation were based on a thorough examination.

Further, the presented study stands out due to the fact that PTs were looking for symptom reproduction and applied the technique in the affected spinal areas. This is worth mentioning as several related studies did not take individual pain states into account at all.

The title of the study gives the impression that the participants only received passive treatments. As it is done in the clinic, they were embedded in an overall management program.